北京市结防机构2019年非结核分枝杆菌临床分离株危险因素及耐药情况分析

Analysis of risk factors and drug resistance of clinical isolates of non-tuberculous mycobacteria in Beijing prevention and control institutions in 2019

目的分析北京市非结核分枝杆菌(nontuberculous mycobacteria,NTM)分离率、菌种分布情况、危险因素及耐药情况。方法采用回顾性调查方法,对本市2019年16个区县及市级结防机构所收集的全部培养阳性的分枝杆菌菌株进行菌群鉴定,所有经鉴定为NTM的菌株采用比例法进行药敏试验,应用SPSS19.0软件对数据进行分析,采用logistic回归模型分析NTM的影响因素,P<0.05时差异有统计学意义。结果北京地区2019年分枝杆菌培养阳性菌株共1254株,鉴定出NTM 81株,分离率为6.5%(95%CI:0.051~0.078),缓慢生长型占59.26%,快速生长型占40.74%;多因素logistic回归分析显示,复治患者(P<0.001)、年龄越大(P<0.001),报告区县为城区(P=0.02)将增加NTM分离的风险;NTM对8种抗结核药物(INH、RFP、SM、EMB、LFX、AK、CPM、PAS)的耐药性分别为97.53%、66.67%、91.36%、77.78%、61.73%、69.14%、74.07%、97.53%。结论NTM菌种分布缓慢生长型、快速生长型趋平均;北京地区NTM分离率随年龄增长而增加,人口密集地区分离率较高;NTM对常用的抗结核药物表现为较高的耐药性,对于耐药及耐多药的结核病患者,应及时进行菌种鉴定。

Objective To analyze the isolation rate,strain distribution,risk factors and drug resistance of nontuberculous mycobacteria(NTM)in Beijing.Methods It used a retrospective analysis to identify all culture-positive mycobacterium strains collected by 16 district/county prevention institutions and municipal Prevention and Control Institute in 2019.All strains identified as NTM were tested for drug sensitivity by proportional method,and SPSS19.0 software was used for data sorting and statistical analysis.Logistic regression model was used to analyze the influencing factors of NTM,and the difference was statistically significant while P<0.05.Results A total of 1254 mycobacterial positive strains were cultured in Beijing in 2019,and 81 non-tuberculous mycobacteria were identified,with an isolation rate of 6.5%(95%CI:0.051~0.078).The slow-growing type accounted for 59.26%,and the fast-growing type accounted for 40.74%.Multi-factor logistics regression analysis showed that the risk of NTM separation increased with patients returning to treatment(P<0.001),older patients(P<0.001),and reporting district(P=0.02).In 81 cases,the NTM was 97.53%,66.67%,91.36%,77.78%,61.73%,69.14%,74.07%,and 97.53%against 8 kinds of anti-tuberculosis drugs(INH,RFP,SM,EMB,LFX,AK,CPM,PAS),respectively.Conclusion The distribution of NTM species tends to be average in slow growth type and fast growth type.In Beijing,the separation rate of NTM increased with age,and the separation rate is higher in densely populated areas.NTM shows high resistance to commonly used anti-TB drugs.Mycobacterium species identification should be conducted in time for drug-resistant and multidrug-resistant TB patients.